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Environmental Health Department <br />I: 1. <br />2. <br />3. <br />4. <br />5. <br /> Other (specify): <br />6. <br />9. <br />meats, tamales, cooked beans, rice, <br />7. <br />8. <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjgov.org/6hd <br />EHD 16-02 Pago 7 of 11 TEMP EVENT APP <br />nR/i«»/isi <br />SAN JOAQUIN <br />COUNTY- ■ <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />Phone: k Alternate: • / <br />List food to be sold or given to the public: . /l?-A }— <br />I am providing food that Is NOT prepared at home^Yes No <br />All food is prepared on-site or is from approved commercial facilities:^ Yes No <br />Na me of facility: Phone. ( ) <br />Address of facility: ______________ <br />I am providing a booth with the following: (to protect my unpackaged food and food-preparation areas frOm files, <br />dust and the public) <br />b <br />A booth with walls and ceiling constructed of either wood, canvas, plastic, similar material and fine mesh fly <br />screening, completely enclosing open food areas. It will also have a smooth and deanabie floor (concrete, <br />asphalt, clean tarps and smooth wood are acceptable) and constructed to separate food and food preparation <br />areas from the public. <br />Note: The only operations not required to provide enclosed booths are those which sell beverages from <br />approved dispensers, or prepackaged foods from approved sources. <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br />Approved bottled water. <br /> On-site hose bib that is connected to a potable water source. <br /> Other (specify): ______________________________ ‘ ■ ■ <br />Electricity Is provided for my booth's use: Yes No <br />I am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous <br />foods during all times of booth operation: Yes No <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br /> Camp stove Sterno & hotel trays j <br /> Double steamer Steam table & lids ■ <br />Q Electric stove top Other (specify) <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />S.r P'Yl(1and are required to return a signed and completed copy of this checklist to <br />the festival coordinator three (3| weeks prior to this event. <br />1. Name of Event: St },/ (Ur 0/1 Mt>AtB(s): <br />The following is information about my organization/business: <br />Name of organization/business.-St^^r /Z " <br />Address: